A Case Report of Hepatic Subcapsular Biloma and Literatures Review_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 张志超 ^1,2 , 胡文秀 ¹ ,  赵海平 ¹

1. ;
2. ;

Corresponding author：

赵海平, Email: zhaohaiping007@aliyun.com

Keywords：

肝包膜下胆汁瘤; 胆囊切除术; 并发症

DOI：

10.7507/1007-9424.20140181

Video：

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目的总结肝包膜下胆汁瘤（HSB）的病因、临床诊断及治疗方法。方法回顾性分析笔者所在医院收治的1例HSB患者的临床资料，并进行文献复习。结果 12例患者中，术前诊断为胆总管结石/胆囊结石慢性胆囊炎4例，胆总管结石1例，胆囊结石2例，急性化脓性胆囊炎2例，不详3例；行腹腔镜胆囊切除术（LC）7例，行内窥镜逆行胰胆管造影1例，行LC+腹腔镜胆管取石术1例，行开腹胆囊切除术3例；发病至手术时间7～40 d，平均14.3 d；右肝9例，胆囊窝及右肝前叶膈顶部、胆囊窝及右肝后叶和左肝各1例；11例单发，1例左肝多发；HSB直径7.6～29.1 cm，平均15.7 cm；肝脏包膜下积液量800～3 000 mL，平均1 400 mL；液体吸收时间7～120 d，平均37 d。主要治疗方案为置管引流7例（包括手术开腹置管外引流2例），B超引导下反复穿刺抽吸4例，1例不详；2例反复穿刺引流效果较差，行手术治疗。结论 HSB的发病原因目前尚无统一意见，诊断首选影像学检查，治疗以保守治疗+B超引导下经皮反复穿刺抽吸为主。

Citation： 张志超, 胡文秀, 赵海平. A Case Report of Hepatic Subcapsular Biloma and Literatures Review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(6): 761-763. doi: 10.7507/1007-9424.20140181 Copy

1.	Cervantes J, Rojas GA, Ponte R.Intrahepatic subcapsular biloma.A rare complication of laparoscopic cholecystectomy[J].Surg Endosc, 1994, 8(3):208-210.
2.	Shamiyeh A, Wayand W.Laparoscopic cholecysteetomy:early and late complication and their treatment[J].Langenbecks Arch Surg, 2004, 389(3):164-171.
3.	Rácz I, Rejchrt S, Hassan M.Complications of ERCP:ethical obligations and legal consequences[J].Dig Dis, 2008, 26(1):49-55.
4.	Leppard WM, Chavin KD, McGillicuddy JW.A what? Subcapsular biloma after laparoscopic cholecystectomy[J].Am Surg, 2011, 77(7):E131-E132.
5.	胡志前,吴德敬,王毅,等.腹腔镜胆囊切除术并发肝包膜下积液二例报告[J].普外临床, 1995, 10(5):260.
6.	陈晚平,唐卫民,宋炜,等.腹腔镜胆囊切除术后肝包膜下胆汁瘤1例报告暨文献复习[J].消化外科, 2005, 4(3):166-168.
7.	Mocanu SN, Rodríguez Blanco M, Palmer Sancho J, et al.Hepatic subcapsular biloma secondary to laparoscopic cholecystectomy[J].Cir Esp, 2012, 90(10):e41.
8.	Ramachandran A, Gupta SM, Johns WD.Various presentations of postcholecystectomy bile leak diagnosed by scintigraphy[J].Clin Nucl Med, 2001, 26(6):495-498.
9.	Hassani KI, Benjelloun el B, Ousadden A, et al.A rare case of hepatic subcapsular biloma after open cholecystectomy:a case report[J].Cases J, 2009, 15(2):7836.
10.	Dupas JL, Mancheron H, Sevenet F, et al.Hepatic subcapsular biloma.An unusual complication of endoscopic retrograde cholangiopancreatography[J].Gastroenterology, 1988, 94(5 Pt 1):1225-1227.
11.	Braithwaite BM, Cabanilla LT, Lilly M.Hepatic subcapsular biloma:a rare complication of laparoscopic cholecystectomy and common bile duct exploration[J].Curr Surg, 2003, 60(2):196-198.
12.	丁雪梅,陈红,张骏,等.胆道术后并发症肝包膜下胆汁瘤一例并文献分析[J].中华肝胆外科杂志, 2013, 19(3):161-164.
13.	沈伟敏,陆贝,封光华.胆囊切除致医源性肝外胆道损伤的外科诊治[J].医学研究杂志, 2012, 41(1):128-130.
14.	刘允怡,赖俊雄.对《胆管损伤的预防与治疗指南(2008版)》的建议[J].中华消化外科杂志, 2008, 7(4):267.
15.	王毅,胡志前,吴德敬,等.腹腔镜胆囊切除术后的少见并发症[J].第二军医大学学报, 2002, 23(6):692-693.
16.	刘永雄.精心保护胆道树:医源性胆管损伤腹部创伤的特殊类型[J].中华肝胆外科杂志, 2009, 15(2):81-83.
17.	Fan MM, Li F, Zhang XW.Changes of the sphincter of Oddi motility in dog after cholecystectomy[J].J Dig Dis, 2012, 13(1):40-46.
18.	Ahn YH, Kim TH, Yang BJ, et al.A case of spontaneous biloma complicated with choledocholithiasis and chronic cholecystitis[J].Korean J Gastroenterol, 2005, 46(2):133-136.
19.	刘永雄.认真研习胆道生物力学重视保护胆胰结构和功能[J].中华肝胆外科杂志, 2012, 18(1):1-4.

1. Cervantes J, Rojas GA, Ponte R.Intrahepatic subcapsular biloma.A rare complication of laparoscopic cholecystectomy[J].Surg Endosc, 1994, 8(3):208-210.
2. Shamiyeh A, Wayand W.Laparoscopic cholecysteetomy:early and late complication and their treatment[J].Langenbecks Arch Surg, 2004, 389(3):164-171.
3. Rácz I, Rejchrt S, Hassan M.Complications of ERCP:ethical obligations and legal consequences[J].Dig Dis, 2008, 26(1):49-55.
4. Leppard WM, Chavin KD, McGillicuddy JW.A what? Subcapsular biloma after laparoscopic cholecystectomy[J].Am Surg, 2011, 77(7):E131-E132.
5. 胡志前,吴德敬,王毅,等.腹腔镜胆囊切除术并发肝包膜下积液二例报告[J].普外临床, 1995, 10(5):260.
6. 陈晚平,唐卫民,宋炜,等.腹腔镜胆囊切除术后肝包膜下胆汁瘤1例报告暨文献复习[J].消化外科, 2005, 4(3):166-168.
7. Mocanu SN, Rodríguez Blanco M, Palmer Sancho J, et al.Hepatic subcapsular biloma secondary to laparoscopic cholecystectomy[J].Cir Esp, 2012, 90(10):e41.
8. Ramachandran A, Gupta SM, Johns WD.Various presentations of postcholecystectomy bile leak diagnosed by scintigraphy[J].Clin Nucl Med, 2001, 26(6):495-498.
9. Hassani KI, Benjelloun el B, Ousadden A, et al.A rare case of hepatic subcapsular biloma after open cholecystectomy:a case report[J].Cases J, 2009, 15(2):7836.
10. Dupas JL, Mancheron H, Sevenet F, et al.Hepatic subcapsular biloma.An unusual complication of endoscopic retrograde cholangiopancreatography[J].Gastroenterology, 1988, 94(5 Pt 1):1225-1227.
11. Braithwaite BM, Cabanilla LT, Lilly M.Hepatic subcapsular biloma:a rare complication of laparoscopic cholecystectomy and common bile duct exploration[J].Curr Surg, 2003, 60(2):196-198.
12. 丁雪梅,陈红,张骏,等.胆道术后并发症肝包膜下胆汁瘤一例并文献分析[J].中华肝胆外科杂志, 2013, 19(3):161-164.
13. 沈伟敏,陆贝,封光华.胆囊切除致医源性肝外胆道损伤的外科诊治[J].医学研究杂志, 2012, 41(1):128-130.
14. 刘允怡,赖俊雄.对《胆管损伤的预防与治疗指南(2008版)》的建议[J].中华消化外科杂志, 2008, 7(4):267.
15. 王毅,胡志前,吴德敬,等.腹腔镜胆囊切除术后的少见并发症[J].第二军医大学学报, 2002, 23(6):692-693.
16. 刘永雄.精心保护胆道树:医源性胆管损伤腹部创伤的特殊类型[J].中华肝胆外科杂志, 2009, 15(2):81-83.
17. Fan MM, Li F, Zhang XW.Changes of the sphincter of Oddi motility in dog after cholecystectomy[J].J Dig Dis, 2012, 13(1):40-46.
18. Ahn YH, Kim TH, Yang BJ, et al.A case of spontaneous biloma complicated with choledocholithiasis and chronic cholecystitis[J].Korean J Gastroenterol, 2005, 46(2):133-136.
19. 刘永雄.认真研习胆道生物力学重视保护胆胰结构和功能[J].中华肝胆外科杂志, 2012, 18(1):1-4.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A Case Report of Hepatic Subcapsular Biloma and Literatures Review

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